Improving Quality Through Clinician Use of Health IT

The purpose of this funding opportunity announcement (FOA) is to investigate novel methods or evaluate existing strategies for clinician use of health information technology (health IT or HIT) in ambulatory settings to improve outcomes through more effective clinical decision support (CDS), medication management, or care delivery. Applicants were encouraged to demonstrate the ability of electronic health records (EHRs) and medication management systems to effectively move evidence-based information to the point of care, including the development/utilization of machine-actionable, evidence-based clinical information to providers and participates in health information exchanges. Applicants were encouraged to consider projects that focus on:

The impact of health IT on outcomes in ambulatory settings and across high-risk transitions of care.

The relationship between health IT and workflow redesign.

Systemic barriers to health IT adoption.

Care for patients with multiple chronic conditions.

Improved use of effective alert strategies for decision support.

Improving Quality Through Clinician Use of Health IT Grants

Twenty-four projects were funded under this FOA. The projects have a diverse range of interventions, using different health IT applications. Many applications target the primary care office as the setting of care while some address the home environment. Many of the projects addressed use effective alert strategies for decision support while others examine the impact of health IT on outcomes in ambulatory settings.

Impact of Office-Based E-Prescribing on Prescribing Processes and OutcomesEstimated Total Funding: $1,199,007Description: Evaluates the full spectrum of e-prescribing by partnering with the makers of an office-based, e-prescribing system that is already in widespread use and with multiple insurance companies and public programs who will provide claims data.Focus Area(s): Impact of health IT on outcomes in ambulatory settings; improved use of effective alert strategies for decision supportType of Health IT: E-prescribingPrincipal Investigator: Michael A. FischerGrant No.: 1R18HS017151Applicant Institution: Brigham and Women's Hospital, Boston, MAEstimated dates: 9/30/2007—9/29/2010

Improving Otitis Media Care With EHR-Based Clinical Decision Support and FeedbackEstimated Total Funding: $877,011Description: Uses Children's Hospital of Philadelphia's EHR to integrate care across time and to supply physicians with the knowledge they need about how to treat a patient at the point of care to address the overuse of antibiotics for otitis media.Focus Area(s): Impact of health IT on outcomes in ambulatory settings; improved use of effective alert strategies for decision supportType of Health IT: Clinical/operational decision support (provider-focused)Principal Investigator: Christopher B. ForrestGrant No.: 1R18HS017042Applicant Institution: Children's Hospital of Philadelphia, Philadelphia, PAEstimated dates: 9/30/2007—9/29/2010

eHealth Records To Improve Dental Care for Patients With Chronic IllnessesEstimated Total Funding: $996,737Description: Conducts a randomized clinical trial to evaluate the effectiveness of an integrated EHR system that includes an EMR, eDental Record, and a personal health record (PHR) to improve the quality and safety of dental care for patients with chronic illnesses.Focus Area(s): Improved use of effective alert strategies for decision supportType of Health IT: Systems integration, clinical/medication reminders (provider-focused)Principal Investigator: James R. FrictonGrant No.: 1R18HS017270Applicant Institution: Healthpartners Research Foundation, Minneapolis, MNEstimated dates: 9/30/2007—9/29/2010

Improving Posthospital Medication Management of Older Adults Through Health ITEstimated Total Funding: $1,199,952Description: Develops and evaluates the value of a health IT-based medication reconciliation system superimposed on the ambulatory EMR to improve the quality and safety of medication management, focusing particularly on the transition from the inpatient to the ambulatory setting for older adults with multiple comorbid conditions who are prescribed high-risk medications.Focus Area(s): Impact of health IT on outcomes in ambulatory settings; care for patients with multiple chronic conditions; improved use of effective alert strategies for decision supportType of Health IT: Quality of care decision supportPrincipal Investigator: Jerry H. GurwitzGrant No.: 1R18HS017203Applicant Institution: University of Massachusetts Medical School Worcester, Worcester, MAEstimated dates: 9/30/2007—9/29/2010

Electronic Prescribing and Electronic Transmission of Discharge Medication ListsEstimated Total Funding: $1,187,674Description: Consists of three studies that will measure the impact of health IT on patient safety in the ambulatory setting.Focus Area(s): Impact of health IT on outcomes in ambulatory settingsType of Health IT: E-prescribing, quality of care decision supportPrincipal Investigator: Rainu KaushalGrant No.: 1R18HS017029Applicant Institution: Weill Medical College of Cornell University, New York, NYEstimated dates: 9/30/2007—9/29/2010

Evaluation of a Computerized Clinical Decision Support System and EHR-Linked Registry To Improve Management of Hypertension in Community-Based Health CentersEstimated Total Funding: $1,132,569Description: Analyzes the efficacy of office-based electronic decision support and provider feedback in improving hypertension control in CHCs.Focus Area(s): Impact of health IT on outcomes in ambulatory settingsType of Health IT: Registries (hypertension), CDSPrincipal Investigator: Helene KopalGrant No.: 1R18HS017167Applicant Institution: Primary Care Development Corporation, New York, NYEstimated dates: 9/30/2007—9/29/2010

Optimizing Medication History Value in Clinical Encounters With Elderly PatientsEstimated Total Funding: $1,199,989Description: Conducts a randomized clinical trial to test geriatric specific algorithms and compliance triggers for improved medication management at the point of care.

Medication Safety in Primary Care Practice—Translating Research Into PracticeEstimated Total Funding: $1,183,549Description: Develops a set of medication safety measures relevant for primary care, incorporates these measures in practice performance reports sent quarterly to participating practices, and assesses the impact of the intervention on the incidence of medication errors.Focus Area(s): Relationship between health IT and workflow redesign; Improved use of effective alert strategies for decision supportType of Health IT: Quality of care decision supportPrincipal Investigator: Steven M. OrnsteinGrant No.: 1R18HS017037Applicant Institution: Medical University of South Carolina, Charleston, SCEstimated dates: 9/30/2007—9/29/2010

A Partnership for Clinician EHR Use and Quality of CareEstimated Total Funding: $1,184,765Description: Studies the effectiveness of a partnership that shares resources and utilizes a data-driven approach to promote full clinician use of an EHR in three nurse managed health centers and three CHCs to improve the quality of care in areas of preventive care, chronic disease management, and medication management for vulnerable populations.Focus Area(s): Improved use of effective alert strategies for decision supportType of Health IT: Quality of care decision supportPrincipal Investigator: Joanne M. PohlGrant No.: 1R18HS017191Applicant Institution: Michigan Public Health Institute, Ann Arbor, MIEstimated dates: 9/30/2007—9/29/2010

A Systems Engineering Approach: Improving Medication Safety With Clinician Use of Health ITEstimated Total Funding: $1,200,000Description: Modifies and implements an IT-based Crew Resource Management tool called ACORN to examine the impact of the intervention on reducing selected adverse drug events among geriatric patients in a primary care setting; examines the impact of the intervention on improving monitoring for geriatric patients on Persistent Medications; and evaluates office staff use and application of the tool for improving geriatric medication safety by examining utilization of the IT tool and changes in safety attitude constructs.Focus Area(s): Impact of health IT on outcomes in ambulatory settingsType of Health IT: Quality of care decision supportPrincipal Investigator: Gurdev SinghGrant No.: 1R18HS017020-01Applicant Institution: State University of New York at Buffalo, Buffalo, NYEstimated dates: 9/30/2007—9/29/2010

Using Information Technology To Provide Measurement-Based Care for Chronic IllnessEstimated Total Funding: $1,196,703Description: Tests the implementation of measurement-based care in an ambulatory care setting with an integrated CDS system and an EHR.Focus Area(s): Improved use of effective alert strategies for decision supportType of Health IT: CDS (provider-focused)Principal Investigator: Madhukar H. TrivediGrant No.: 1R18HS017189Applicant Institution: University of Texas Southwest Medical Center at Dallas, Dallas, TXEstimated dates: 9/30/2007—9/29/2010

Internet Citation: Ambulatory Safety and Quality Program: Health IT Portfolio (continued): Improving Quality Through Clinician Use of Health IT .
July 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/factsheets/informatic/ambsafety/ambulatory-safety-2.html